Dental EHR Implementation: Factors and Outcomes

The University of Texas Health Science Center (UTHSC) at Houston Dental Branch implemented electronic patient records for all dental clinics, and a team of researchers interviewed them approximately four months after implementation, conducted surveys pre- and post-implementation and read through project documents to construct a case study of pitfalls and successes.

Being a large institution, a variety of people participated in the process, and many of the interviews revealed that the range of knowledge necessary to select, negotiate and implement the EDR was immense. A clinician champion with a strong grasp of IT was also key to the success of the project. UTHSC also anticipated changes in workflow and began changing processes and behaviors before implementation.

That didn’t mean implementation went entirely smoothly; one clinic had problems with patients who prepaid for visits not being documented, and thus not charged for later visits either. The switch to digital images led to challenges with availability, processing and storage locations for sharing. The initial pilot found the digital imaging system nearly unusable, and significant modifications had to be made. Various bugs were found in the software, requiring negotiation with the vendor to get fixes.

These kinds of problems have been commonly documented in literature on ambulatory and hospital electronic record implementations. The need for strong imaging is key to successful utility of a dental-focused EHR, and is also the hardest need to meet.

User perceptions did change in the four months after implementation. In particular, after using the electronic record, users were more likely to think the system secure–even compared to paper records. Users were also more likely to recommend electronic records to other practices. Legibility and improved access were the most common reasons to like the system.

Lessons Learned:

Many types of skills are needed to successfully implement an EDR.

Users perceive benefits after only a few months.

Data and usability problems often have to do with the imaging system, which is a vital feature for a dental EHR.